<p>Additional files</p><p>Additional file I: Appendix</p><p>A sample of clinical reasoning tests </p><p>One example of each clinical reasoning test are mentioned below</p><p>1-Example of a KF test item</p><p>The patient, a 60-year-old male, comes to the emergency room with a chief complaint of vertigo and diplopia. The patient reports a history of hypertension. On physical examination his pupils are reactive and normal. </p><p>What is your most probable diagnosis?</p><p>With respect to your diagnosis, which elements of his history and physical examination would you particularly want to elicit? (Select up to 4)</p><p>A: Horizontal nystagmus</p><p>B: Vertical nystagmus</p><p>C: Nausea and vomiting</p><p>D: Increased vertigo on Valsalva maneuver </p><p>E: Gait disturbance</p><p>F: Positional vertigo</p><p>G: Tinnitus</p><p>H: Hearing loss</p><p>I: Slurred speech</p><p>J: Response to Antihistamines</p><p>K: Fever</p><p>L: History of trauma</p><p>M: History of ear infection</p><p>N: History of drug use O: Improvement on Dix-Halpike maneuver</p><p>2-Example of an SCT item</p><p>A 65-year-old male comes to the emergency room with chief complaint of hematuria. He has a </p><p> history of diabetes mellitus and hypertension from 10 years ago and diarrhea from 3 days ago. </p><p>Serum creatinine: 2.5 mg/dL</p><p>If you are thinking of And then you were to find This hypothesis would become Acute renal failure with Improvement of symptoms by -2 -1 0 +1 +2 intrinsic causes prednisone Prerenal azothemia Lower leg edema -2 -1 0 +1 +2 Aminoglycoside poisoning History of vomiting -2 -1 0 +1 +2</p><p>Scoring key:</p><p>-2 Ruled out or almost ruled out</p><p>-1 Less probable</p><p>0 Neither less or more probable</p><p>+1 More probable</p><p>+2 Certain or almost certain 3-Example of a CRP test item</p><p>The patient is a 46-year-old diabetic man who comes to the emergency room with chest pain since 2</p><p> hours prior to admission that lasts for 20 minutes. Now he has no pain and his EKG is normal. His </p><p> blood sugar is well controlled with glybenclamide. Past history is significant for 10 pack/year </p><p> smoking and chest pain after walking. His pain was reduced with TNG and warm liquids. This time </p><p> he experienced pain after a heavy meal diet and the pain was not improved by hot liquids.</p><p>1) What do you think the most likely diagnosis is for this patient?</p><p>A: Stable angina</p><p>B: Pleurisy</p><p>C: Esophageal spasm</p><p>D: Spontaneous pneumothorax</p><p>E: Biliary colic</p><p>F: Unstable angina</p><p>2) Please list the features of the case which you consider to support your diagnosis and those which </p><p> oppose it, giving an appropriate sign [positive (+) or negative (-)].</p><p>Features Supports (+) or opposes (-)</p><p>3) If this diagnosis proved incorrect, what would your next choice be? A: Stable angina</p><p>B: Pleurisy</p><p>C: Esophageal spasm</p><p>D: Spontaneous pneumothorax</p><p>E: Biliary colic</p><p>F: Unstable angina</p><p>4) Please list the features of the case which you consider to support your diagnosis and those which</p><p> oppose it, giving an appropriate sign [positive (+) or negative (-) ].</p><p>Features Supports (+) or opposes (-)</p><p>4- Example of a CIP test item History</p><p>1- A 30-year-old female with joint pain</p><p>2- A 20-year-old male who recently returned from a trip abroad</p><p>3- A 20-year-old male with fatigue and epitasis</p><p>4- A 70-year-old male with fever and sever respiratory distress</p><p>5- A 50-year-old female with dry cough and dyspnea</p><p>6- A 52-year-old female who received heparin prophylaxis</p><p>Past medical history</p><p>1- Not significant </p><p>2- History of skin hypersensitivity</p><p>3- Not significant except allergy</p><p>4- Three-day admission in CCU 1 month ago but after work-up coronary artery disease was ruled out</p><p>5- History of COPD and diabetes mellitus </p><p>6- History of bloody diarrhea</p><p>Physical examination</p><p>1- Diffuse ecchymosis, normal spleen, no lymphadenopathy, harsh breathing sounds in lower quadrant of right lung</p><p>2- Swelling and warmth in right upper extremity </p><p>3- Petechiae in extremities, normal spleen, no lymphadenopathy, pale conjunctiva</p><p>4- Diffuse expirational wheezing, no fever </p><p>5- Petechiae in extremities, splenomegaly and lymphadenopathy</p><p>6- No arthritis, butterfly rash on face </p><p>1- CIP answer sheet </p><p>BUN=35 mg/dL WBC=6000/mm3 Hb=6 g/dL ANA= negative Cr=2 mg/dL C3= normal C4= normal CH50= normal PLT=25000/mm3 PT=12" PTT=32"</p><p>2- BUN=13 mg/dL WBC=8000/mm3 Hb=13 g/dL ANA= negative</p><p>Cr= 0.6 mg/dL C3=NL C4= normal CH50= normal PLT=30000/mm3 PT=normal PTT= normal</p><p>3- BUN=30 mg/dL WBC=30000/mm3 Hb=14 g/dL PT=18" 3 Cr=1.8 mg/dL C3= normal PLT=50000/mm PTT=50"</p><p>4- BUN=30 mg/dL WBC=100000/ Hb=13 ANA= PLT=10000/mm3 mm3 g/dL negative</p><p>Cr=1.6 mg/dL C3= normal C4= CH50= PT=12",PTT=35" normal normal</p><p>5- BUN=14 mg/dL WBC=6000/mm3 Hb=10 g/dL PTT= normal Cr= .6 C3= normal C4= normal ANA= negative PLT=30000/mm3 PT=normal CH50=normal</p><p>6- BUN=40 mg/dL WBC=3000/mm3 Hb=11 g/dL ANA= +</p><p>Cr= 2.5 mg/dL CH50= Low C4= Low PLT=50000/mm3 PT=12" PTT= 30"</p><p>History Past medical Physical Laboratory data history examination A B C D E F</p>